Individual
LAURIE L. EASTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, SAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16306-131
WI
1041C0700X
Clinical Social Worker
Primary
7805-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000084908-K400277773
WI MEDICARE
WI
01
—
1942669346
DEANHEALTH PLAN
WI
05
—
1942669346
—
WI
01
—
701839
MERCYCARE INSURANCE
WI
Enumeration date
02/15/2016
Last updated
04/25/2019
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